A journey of hope and healing after a decade of infertility and two maternal near-misses.

Wednesday, March 7, 2018

Our Story Part 17: Waiting and Fading

This post has been a long time coming. If you have been following along over the last two years, you've probably noticed there is a huge gap between Part 16 and 17. Thanks to super vague hospital discharge papers, I didn’t know exactly what procedures I had, how much blood I lost, how much blood I received or where my internal bleeding originated. Every doctor appointment since my hospitalization has provided snippets of the unknown, new information gleaned during routine medical history assessments, leaving me with even more questions and a lack of answers. I think it was a combination of my doctors not wanting to overwhelm me with all of these facts during such a fragile time early on and my inability to register what they were telling me. I was so deep in survival mode that I inadvertently shut out a lot. Even now, random bits of conversations I had with doctors from the confines of my hospital bed will come back to me.

Before writing this, I felt I had to know more of the details and somehow that would help me pull the heavy things up again. I always knew these next few posts would be- by far - the most challenging to write and I wanted to convey what a tremendous battle it was. Maybe it’s my scientist brain craving the accuracy. Maybe it's to finally quell the naysayers. Maybe it’s something else entirely. All I know is that a mixture of avoidance and life delayed me from making my way to the medical records office at the hospital. And if I’m honest with myself, a big part of me was afraid of what the records would say. Was it as bad as I remember? Was it much worse and God protected me from knowing too much too soon? Does knowing the answer really make a difference about the way I feel about my trauma anyway?

This past November I trekked to the hospital to find out, or at least have a giant stack of papers in my possession to begin piecing together what happened more clearly. I was surprised that the woman standing outside the office with her two year old in a stroller was still just as shell shocked as she was the day she left the 6th floor. As I retraced some of my steps and reoriented myself with the building from an entirely different vantage point, I realized that feeling is likely never going away.

When the kind man handed me a box instead of a packet an hour later, reality began to set in. I cried walking back to my car. I have a freaking box! It took me another two months before I had the courage to crack it open. When I finally felt brave enough to look at the records, I only got to around page 50 of 1000 from the first of three hospitals before I had to stop. Reading phrases like “acuity level 1” and “massive transfusion protocol” was chilling but I pressed on, sifting through the pages and pages of transfusion documents too, tearing up when I realized I was infused every 40 minutes leading up to my surgery. My mouth dropped when I got to my surgeon’s notes.

I learned a lot that afternoon but what struck me the most was that I really already knew. I didn’t need to read the Emergency Room vitals that showed at 1:32pm my blood pressure was 55/43 and then sixteen minutes later at 1:48pm it was 37/25. I didn’t need to read the details to know that I had been crashing that afternoon. My body knows what it survived. The rest of me is just catching up. Blocking out the specifics was my coping mechanism and I now believe it was God’s way of giving me what I could handle in small increments, knowing the weight of all of this at once would certainly break me.

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October 11, 2015, about 4pm

Once it was confirmed that I was bleeding internally, it became clear that the biggest hurdle to keeping me alive was to stabilize my blood pressure and coagulation. Since I had two pulmonary emboli during my pregnancy, I was still on the blood thinners postpartum. The risk of a blood clot is already high after delivery, even more so after a c-section surgery, and my history of PEs made this risk exponentially greater. In the days after birth, my pulmonologist switched me from an injectable blood thinner (enoxaparin) to an oral medication (warfarin) which is known to be erratic in the early stages of therapy. He did this for two reasons: first, the oral medication is a teratogen (causes birth defects) and obviously was not a safe option for me to take until after delivery. Second, it would be a huge quality of life improvement not having to stick myself with a needle twice per day. While my levels on the oral blood thinner were initially within the therapeutic range when I was discharged after my c-section, it spiked to around double the anti-coagulation within the days that followed. I now had a supratherapeutic INR.

Reversing the effects of the blood thinner was no easy task. I was put on an IV drip to help stabilize my blood pressure and then the ER doctor started me on multiple transfusions. I received whole blood, packed cells, plasma and platelets. I received so much, I honestly didn’t know how many bags I received of each. For two years we have estimated it to be around 6-8 units which is one of the reasons why the medical records blew my mind. At the very least, I received more than double what we thought.

When I tell you that blood donation saves lives, it is one of the reasons I am sitting here writing now. It sounds trite to say that ‘blood donations save lives’ but at least SEVEN LITERS OF BLOODgave me a shot at surviving multiple conditions that made up the perfect storm of a maternal catastrophe. That's more than my entire blood volume and that's just what I know of from the first 50 pages of my records. We are a little family of three, in part, to the selfless blood donors who took the time to give of themselves. And now the lifesaving gift of their blood will run through my veins for the rest of my life. Why am I a relentless advocate for blood donation, you ask? This is why.

There was a lot of uncertainty and waiting that day and night. Waiting for blood test results and scan results. Waiting for heavy narcotics to ease my excruciating pain. Waiting for a room. Waiting for the doctors to decide on the path forward that gave me the best chance of going home to my baby again. Waiting for them to figure out how I could survive this.

I was moved to an open space with three other people in the ER because another trauma patient arrived and needed the unit I was previously in. I thought that was a good sign… I must be improving if I’m not in trauma anymore. My husband followed and then my sister arrived to sit with us while my mom took care of our son at home. They tried to keep me in good spirits and took great care of me while my nurse managed a double patient load. Initially, the doctors hoped that reversing the blood thinners would be enough for my blood to clot on its own but time indicated otherwise. One of the CT scans revealed I had two potential areas where I was bleeding and when they told me where, I was not surprised. The scans showed the two places I had been experiencing the most pain for over 24 hours. The scan also helped me to realize how deep in the woods I really was. The nurses had to lift my body from the gurney to the scan table and being completely horizontal felt like my body was being sawed in two!

An hour or so later, I was wheeled from the ER to a new ward. My room was very small and dark and it could barely fit more than three people at a time. My husband and sister were there to help me settle in and that was when I heard the words “surgical intensive care unit”. Two doctors from the OB/Gyn group introduced themselves soon after and told me they would make a final determination about their plan for surgery after seeing the results from my next blood draw. They urged my husband and sister to go home and get some rest and assured Adam they would call him if anything changed. My sister left around 10pm that night and Adam lingered until midnight or so.

That was the night I met Addison* and she was a sweetheart of a nurse. She, too, was in a unit that was understaffed and had four critical patients when she should have only had two. She was so kind in helping me to get a pump so I could try to keep my milk supply going- as crazy as it sounds, one of my biggest concerns was losing my supply because I was away from my son for so long. She made sure I was comfortable and had a pain reliever that was working because the previous hydromorphone dosage wasn’t cutting it. I fell asleep for what felt like hours thanks to a nice dilaudid bolus.

When I woke up, my husband was back at my bedside holding my hand and his face was wet. Confused, I asked him why he was back so soon. I had no idea what time it was but I figured it was only 4 or 5am.

Him: (tears streaming) The doctors called me and told me to come now.

Me: Well, that can’t be good.

Well I, I've got a lot to say
And I'm scared, that you're gonna slip away
And you, you've got this wide-eyed gaze
And a smile, that you'll carry through your days

The things that I thought would last
Well they're fading, they're fading

About the Author: Casey Cattell struggled with infertility for more than a decade before giving birth to her son, Nathan, in 2015. She is a two time Maternal Near Miss Survivor writing to give hope to women in the midst of hardships that challenge their faith. She also enjoys sharing her latest creative exploits. Casey and her husband live in the Northeast, USA and in their downtime like to explore new places and hike with their young son. If you liked this post or were encouraged by it, please consider passing it on. Find Casey on Instagram and Twitter.